New health law will not ration medical care

By Arthur Garson Jr. and Carolyn Long Engelhard

Updated 8:48 pm, Friday, February 10, 2012

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New health law will not ration medical care

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One-third of Americans recently surveyed said the new health law would allow a government "death panel" to make decisions about end-of-life care. They are dead wrong. Former Gov. Sarah Palin charged in 2009 that the proposed legislation would decide whether dying Americans were worthy of medical care. Not so. Early drafts of the legislation did include a section that paid physicians for providing voluntary counseling to Medicare patients about advance directives and end-of-life care options, but the language never made it into the final legislation. In our view, these kinds of discussions among physicians, their patients and families should be required; they want information so they can decide for themselves how much care they want. They understand that more is not always better. In fact, studies show that patients want 40 percent less care than is sometimes recommended by a physician.

Another controversial element of the law is the idea of conducting research on what treatments work best. Some fear that this initiative will lead to rationing certain medical services. But think about it: Does the research done by Consumer Reports lead to rationing? Of course not, and Consumer Reports even compares prices - which is specifically prohibited from Medicare and from the new health law. Shouldn't we foster the same kind of comparisons in health care as we do for a brand of shirt in order to know which is the best in terms of cost and quality?

Fears of health care rationing are emotional reactions. What is the reality? Most Americans agree that everyone should have shelter, food and decent health care. But everyone can't have everything. Currently, the cost of health care is too high, leading to more uninsured, global noncompetitiveness and budget deficits. We had enough money when people died in their 60s - but not anymore. The last year of life for Americans now costs the U.S. about $300 billion (three times as much as the uninsured).

We now accept that not everyone deserves a home mortgage regardless of the cost. But when it comes to expensive, marginally effective medical care, we feel differently. We will not accept that $17,000 per month for a drug that prolongs life by five weeks may be too much. Most will likely agree that rational allocating of resources is necessary. But watch what happens when rational allocating becomes rationing. We resist rationing because someone else (insurers, the government) usually pays for it, and we want everything to be available for ourselves and our families.

It is time to begin open discussions about how to deal with expensive, minimally effective, medical care with patients, families, professionals and ethicists and not the medical industrialists who gain from prolonging life at every expense. Declaring rationing the third rail doesn't help anyone. It is time to allow the Food and Drug Administration to set high bars for value (including both cost and effectiveness) in approving new drugs and devices, and to allow Medicare to consider cost in what it covers. Delaying these discussions is like kicking the can down the road in the deficit discussions - not helpful now or for future generations.